Psilocybin Exposures Reported to U.S. Poison Centers: National Trends Over a Decade.

PURPOSE: We describe trends in psilocybin exposures among adolescents and young adults as reported to US poison centers over the past decade. METHODS: We queried the National Poison Data System for cases involving psilocybin during January 1, 2013-December 31, 2022. Persons aged 13-25 years were included. We examined exposures to psilocybin by demographics, clinical effects, level of care, and medical outcome. RESULTS: During the 10-year study period, 4,055 psilocybin-involved exposures were reported among adolescents and young adults, 2,667 (65.8%) being single substance exposures. Most single substance cases received medical attention (adolescents: 75.3% [n = 1,176], young adults: 72.1% [n = 797]). We did not find significant change in the number of cases during 2013-2018. Cases started increasing in 2019. In 2022, cases more than tripled among adolescents and more than doubled among young adults, compared to 2018 (p < .0001). DISCUSSION: Continued national surveillance is critical to determine the impact of psilocybin exposures on youth as it becomes increasingly available.

Administration of andexanet alfa for traumatic intracranial hemorrhage in the setting of massive apixaban overdose: A case report.

PURPOSE: Apixaban is a direct-acting oral anticoagulant that selectively inhibits factor Xa. Reversal strategies utilized to treat factor Xa inhibitor-associated bleeding include andexanet alfa, prothrombin complex -concentrate (PCC), and activated PCC (aPCC). The optimal treatment of traumatic intracranial hemorrhage in the setting of an apixaban overdose is unknown. SUMMARY: This case report describes a 69-year-old female who initially presented to an emergency department at a community hospital due to a ground-level fall with traumatic intracranial hemorrhage. The patient reportedly ingested apixaban 275 mg, carvedilol 250 mg, atorvastatin 1,200 mg, and unknown amounts of amlodipine and ethanol. Anti-inhibitor coagulant complex, an aPCC, was administered approximately 3 hours after presentation. Initial thromboelastography performed approximately 4 hours after presentation showed a prolonged reaction time of 16.8 minutes. Ongoing imaging and evidence of coagulopathy prompted repeated aPCC administration to a cumulative dose of approximately 100 U/kg. The patient underwent craniotomy with hematoma evacuation. Postoperative imaging showed expansion of the existing intracranial hemorrhage and new areas of hemorrhage. Andexanet alfa was administered approximately 18 hours after presentation, followed by repeat craniotomy with evacuation of the hematoma. No further expansion of the intracranial hemorrhage was observed, and the reaction time on thromboelastography was normalized at 6.3 minutes. CONCLUSION: This case suggests that andexanet alfa may have a role in the management of traumatic hemorrhage in the setting of an acute massive apixaban overdose. Use of andexanet alfa, PCC, and aPCC in this context requires further research.

Postoperative chest radiograph after open reduction internal fixation of clavicle fractures: a necessary practice?

HYPOTHESIS/BACKGROUND: Iatrogenic pneumothorax is a rare but serious complication of open reduction and internal fixation (ORIF) of clavicular fractures. Many institutions use postoperative chest radiographs to evaluate for this complication despite a lack of data to support this routine practice. Due to concerns of radiation exposure and health care costs, this practice may not be necessary. This study determined the rate of iatrogenic pneumothorax after clavicular ORIF with plate fixation at a single institution over 8 years. We hypothesized that postoperative chest radiographs would identify a very low rate of pneumothorax in patients with isolated clavicular fractures with no serious preoperative pulmonary injury. METHODS: A retrospective review was performed identifying all patients undergoing clavicular ORIF with plate fixation at a single Level I trauma center by 3 board-certified orthopedic surgeons from 2009 to 2017. Patients without at least 1 postoperative chest radiograph were excluded. We determined patient demographics and rate of preoperative and postoperative pneumothorax. RESULTS: We identified 89 patients without preoperative pneumothorax who underwent clavicular ORIF with at least 1 postoperative chest radiograph. Within this group, no patients (0%) had a new postoperative iatrogenic pneumothorax. DISCUSSION/CONCLUSION: Within this series of 89 patients with isolated clavicular fractures without preoperative pneumothorax, no iatrogenic pneumothoraces occurred after plate fixation. Therefore, for patients undergoing ORIF of isolated clavicular fractures obtaining a postoperative chest radiograph may be an unnecessary practice, especially given their low sensitivity. Future high-powered studies are needed to validate this finding.